185005 04/28/2010 CITY OF CARMEL, INDIANA VENDOR: 355244 Page 1 of 1
4 ONE CIVIC SQUARE COMPLETE MASONARY SERVICES INC CHECK AMOUNT: $13,700.00
CARMEL, INDIANA 46032 4631 S COUNTRY RD 700 WEST
PO BOX 236
CHECK NUMBER: 185005
YORKTOWN IN 47396
CHECK DATE: 4/28/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 16 13,700.00 PERFORMING ARTS CENTE
1992
1 ����NN 0�~�/�~
Application and Certificate: for Payment Construction Manager-Adviser Edition
TO OWNER: PROJECT: APPLICATION NO:
Distribution to:
CARMEL REDEVELOPMENT COMMISSION REGIONAL PERFORMING ARTS CENTER
PERIOD TO: OWNER El
ONE CIVIC SQUARE CARMEL, INDIANA
CARMEI_j:IN 46032 CONSTRUCTION MANAGER El
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: C ONTRACT DATE: ARCHITECT 1:1
COMPLETE MASONRY SERVICES, INC.
PROJECT NOS: I CONTRACTOR 171
P.O. BOX 236 SHIEL SEXTON CO., INC. CMS 08-07
vnnxrovvw./w4ruya VIA ARCHITECT: AGREEMENT NO. 2685-4010 FIELD O
CONTRACTFOW. *4010-INTEmonmASOwRY CSO ARCHITECTS INC- O
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
Application is made for payment, as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the
Continuation Sheet, AIA Document G703, is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous
Certificates for Payment were issued and payments received from the Owner, and that current
State of:
ERIC J. KELLY, PRESIDENT
5, RETAINAGE:
County of:
/u*u/ /uu*/�
a Subs PE to For;
(Column D +EooG703) 106.084.60
b. `oo ��n�9�nn*�D�uu�n) �v/m7pvh|ic��x MARCH, 2010
m
(Column Po"07C8) 0 My Commission exp
Total netuiov@e (Lines no+5bo, Total io Column |"/G7on)' CERTIFICATE FOR PAYMENT
1oxcco�uncev�b the Contract Dncumemn h,00douoo deobu�vabonxundthcdmu"ommdxiog
0�TOTAL�ARNEDLES3RETA|NAGE----�----------- �UOS�124O t his the Cono'muinMa^ugona Aruhi�v/c w the Owner that /n the best v(their
(Line 4 Less Line 5Total) knowledge, informa and belief the Work has progr as indicated, the quality of the Work is in
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 1 uccon|unucwi(hV`^CnotructDocumvnts.undthoCvo/muo,iumddcd/opuyrucmofthe4MVQNT
CuuTc,|so
(Line Certificate)
D.CURRENTPAYMENTDUE AMOUNT
^r
wxumc*nu"unm�«uomvo,mnm"""upv
�BALAm����F|N|GH.|NC�VD|
ontinuation
(Line 3less Line 6) 11647980
YCTI
CHANCE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHI
Total changes.appr previous months by Owner 1 i526.00 $13,834.00 By: Date: W
Total approvedthis Month 0.00 0.00 This Certificate is-not negotiable. The AMOUNT CERTIFIED is payable only to le Contractor
TOTALS named herein. Issuance; payment and acceptance of payment are without prejudice to any rights of
1,$526.00 $13,834,00 the Owner or Contractor under this Contract.
NET C14ANGES by Change Order -1 �ns on
Cuunom You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
«mDocument American I of m*= is Document
Purchasers are permitted to repmvmmwoo"/com/'mmm/s000umawwhen completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, roprighw*mao�.
4Document G702/CMa"m- 1992 Instructions
Application and Certificate for Payment Construction Manager Adviser Edition
A. General Information
AIA Document G7021CMa, Application and Certificate for Payment, Construction Manager- Adviser Edition, is to be used in conjunction with AIA Document G703,
Continuation Sheet. These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner, but not as a
constructor, and where multiple Contractors have direct Agreements with the Owner. Procedures for their use are covered In AIA Document A201 /CMa, General
Conditions of the Contract for Construction, Construction Manager- Adviser Edition, 1992 Edition.
B. Reproductions
This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to
reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document.
The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702 /CMa, but only for use in connection with a particular
project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission
from the AIA.
Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA).
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright@aia.org.
C. Completing the G7021CMa Form
After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G702 /CMa, Application and
Certificate for Payment, Construction Manager- Adviser Edition,
The Contractor should sign G702 /CMa, have it notarized and submit it, together with G703, to the Construction Manager and Architect.
The Construction Manager and Architect should review G702 /CMa and G703 and, if they are acceptable, complete the Certificate for Payment on G702 /CMa. The
Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201 /CMa. They should then initial all figures
on G702 /CMa and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 /CMa and G703 should be forwarded
to the Owner.
D. Completing the G703 Form
Heading: This information should be completed to be consistent with similar information on AIA Document G702 /CMa, Application and Certificate for Payment,
Construction Manager- Adviser Edition.
Columns A, B C: These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of
values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors
and should remain consistent throughout the Project. Multiple pages should be used when required.
Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum.
The total of column C may be adjusted by Change Orders during the Project.
Column D: Enter in this column the amount of completed work covered by the previous application (columns D E from the previous application). Values from column F
(Materials Presently Stored) from the previous application should not be entered in this column.
Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated into the project which were listed on the
previous application under Materials Presently Stored (column F).
Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period.
This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment
by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this
column and incorporated into column E (Work Completed This Period).
Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C.
Column H, Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column I: This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on projects where a
constant retainage is withheld from the overall contract amount.
Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not
normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract
adjusted by Change Orders is to be entered in the appropriate location on the G702 /CMa form.
Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change
Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A2011CMa.
E. Making Payment
The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager and '-Architect on AIA Docug ent G702 /CMa,
Application and Certificate for Payment, Construction Manager- Adviser Edition. The completed form contains the name and address of the Contraetof. Payment should
not be made to any other party unless specifically indicated on G702 /CMa.
A145ocument G7021CMaTm 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S.
Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal
penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed.
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright@aia.org.
AIA Document G703TM -1992
Continuation Sheet
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT APPLICATION NO
containing Contractor's signed certification is attached. COMPLETE MASONRY SERVICES INC. 16
In tabulations below,. am APPLICATION DATE:
amounts are stated to the nearest, dollar. AGREEMENT #2695 -4010 03115/2010
Use Column I on Contracts where variable retainage for line items may apply. CMS JOB NO, 08 -07 PERIOD TO: 03/31/2010
RETAINAGE 10% UNTIL 50% COMPLETE ARCHITECT'S PROJECT NO:
A B C D E F':' G H I
WORK COMPLETED MATERIALS TOTAL
BALANCE
SCHEDULED FROM PREVIOUS
PRESENTLY COMPLETED TO RETAINAGE
ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE
NO VALUE APPLICATION THIS PERIOD (NOT W TO DATE (G C) FINISH RATE)
(D E) D OR E) (D +E +F) (C G)
1 BOND 20000 20000 20000 00% 0
2 MOBILIZATION 3000 3000 3000 00% 0
3 DE- MOBILIZATION 3000 2000 1000 3000 00 0 /0 0
4 INS /HAZCOM /SAFETY 12000 11875 125 12000 00 0
5 SUBMITTALS 15000 15000 15000...: 00% 0
6 DAILY CLEAN UP 22000 21875 125 22000 00% 0
7 CLOSE OUT 8000 8000 8000 00% 0
8 FOUNDATION CMU
LABOR 48000 48000 48000 00%
0
MATERIAL
CMU 5000 5000 5000 00% 0
REBAR 3500 3500 3500 00% 0
GROUT 5250 5250 5250 00% 0
SHEET METAL 2000 2000 2000 00% 0
MORTAR AND SAND 1250 1250 1250 00% 0
ACCESSORIES 4250 4250 4250 00% 0
9 BASEMENT /PLENIUM CMU
LABOR 270000 270000 270000 00% 0
MATERIAL
CMU 26500 26500 26500 "I00% 0
REBAR 16650 16650 16650 00% 0
GROUT 31500 31500 31500 100% 0
SHEET METAL 10000 10000 10000 00% 0
MORTARAND SAND 7000 7000 7000 00% 0
0 24000 00% 0
SUB -TOTAL 1 537900 1 528650 1 9250 1 0 537900 00% 0 1 0
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright
Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright @aia.org.
1 Document G703"— 1992 Instructions
Continuation Sheet
GENERAL INFORMATION
Purpose and Related Documents. AIA Document 6702, Application and Certificate for Payment, is to be used in conjunction with AIA
Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the
Owner. Procedures for their use are covered in AIA Document. A201, General Conditions of the Contract for Construction.
Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify
the most recent edition.
Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the
AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further
rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed
G703, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction
granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users
ofAIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA
Contract Documents, e -mail The American institute of Architects' legal counsel, copyright cr aia.org.
COMPLETING G703 -1992
Heading. This information should be completed in a manner consistent with similar information on AIA Document G702, Application and
Certificate for Payment.
Columns A, B C. These columns should be completed by identifying the various portions of the Project and their scheduled values consistent
with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by
sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required.
Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the
original Contract Sum. The total of column C may be adjusted by Change Orders during the Project.
Column D. enter in this column the amount of completed Work covered by the previous application (columns D E from the previous
application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column.
Column E. Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that
were listed on the previous application under Materials Presently Stored (column F).
Column F. Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end
of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet
incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials
are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed —This Period.)
Column G. Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C.
Column H. Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column 1, This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on
projects where a constant retainage is withheld from the overall contract amount.
Change Orders. Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the
Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule_
The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form.
Construction Change Directives. Amounts not in dispute that have been included in Construction Change Directives should be incorporated into
one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201.
Thefollowing is an example of a Continuation Sheet for work in progress. Please note that dollar amounts shoran below arefor illustrative purposes only, and are
not intended to Deflect actionl consiruction costs.
A B C D
WORKCOMPLETEI) ,MATERIALS TU'rAL
BALANCE;
PRESENTLY CO,MPLETCD n RE'TA1N'AGE
ITEM SCHEDULED FROM PREVIOUSS TO
DESCRIPTION OF WORK 5'rORED AND STORED (11 VARIN3LF
N0. VAL11F. APPLICATION THIS PEREOD {NOT IN 'r0 DA "I'I; L) 1'IN'IS II RATE)
(15r E) DOR E) (D +E +17 iC
1 MOBILIZATION 5,000 5,000 0 C 5,000 100 0
2 STUMPREMOVAL 5,000 5,000 0 0 5,000 100 0
3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0
4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000
5 CURBS 6 MISG. CONC. 5,000 0 0 0 0 0 5,000
6 PAVING, UPPER DRIVE 20,000 0 0 c 0 0 20,000
7 PAVING, LOWER DRIVE 20,000 0 c 0 0 0 20,000
8 PAVERS 20,000 0 0 10,0D0 10.000 50 10,000
9 BRICK WORK 5,000 0 0 0 0 0 5,000
10
11 105,000 20,000 10.00c I0,000 1 40,000 65,000
T AIA Document G703TM –1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING:
This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any
portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to
reproduce ten (10) copies of this document When completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright@aia.org
/l
TM
Document G703 -1992
Continuation Sheet
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATIOKNO:
containing Contractor's signed certification is attached. COMPLETE MASONRY SERVICES INC. APPLICATION DATE: 16
In tabulations below, amounts are stated to the nearest dollar. AGREEMENT #2695 -4010 03/15/2010
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: CMS JOB NO. 08 -07 03/31/2010
ARCHITECT'S PROJECT NO:
RETINAGIE A B 7SCHE-DULED D o o -E—TE G H I
WORK COMPLETED MATERIALS TOTAL
BALANCE
OM PREVIOU S PRESENTLY COMPLETED %a TO RETAINAGE
ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE
NO. PPLICATION THIS PERIOD (G C) FINISH
(NOT IN TO DATE RATE)
(D E) D OR E) (D +E +F) (C G)
10 ORCHESTRA LOW /HI CMU
LABOR 325000 323000 2000 325000 00% 0
MATERIALS
CMU 30500 30250 250 30500 00 0
REBAR 21000 21000 21000 00% 0
ROUT 32000 31700 300 32000 00% 0
SHEET METAL: 12000 12000 12000 00% 0
MORTAR:.AND.,SAND 8000 7900 100 8000 00% 0
CCESSORIES 28000 28000 28000 00% 0
11 BOX TIER CMU
LABOR 175000 175000 175000 00% 0
MATERIALS
MU 23500 23500 23500 00% 0
REBAR 10000 10000 10000 00% 0
ROUT 19000 19000 19000 00% 0
SHEET METAL 5500 5500 5500 00% 0
MORTAR AND SAND 4500 4500 4500 00% 0
ACCESSORIES 15600 15600 15600 00% 0
12 BALCONY LOW CMU
LABOR 198000 197000 1000 198000 00% 0
MATERIALS
MU 19000 18900 100 19000 100% 0
REBAR 12000 12000 12000. 00% 0
ROUT 19500 19400 100 19500 00 0
SHEET METAL 6000 6000 6000 00% 0
MORTAR AND SAND 5000 4900 100 5000 00% 0
1000 11000 1000 00°0 0
UB —TOTAL 1518000 1504800 13200 0 1518000 00% 0 0
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G703TM+ —1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright
Law and International Treaties. Unauthorized reproduction or distribution of this AleDoeument, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright aia.org.
72ioll Document G703"— 1992 Instructions
Continuation Sheet
GENERAL INFORMATION
Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA
Document G703, Continuation Sheet_ These documents are designed for use on Projects where the Contractor has a direct Agreement with the
Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction.
Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify
the most recent edition.
Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the
AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further
rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum often copies of a completed
G703, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction
granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users
of AIA software. Licensed AIA software users should consult the End User License Agreement (FULA)- To report copyright violations of AIA
Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright a aia.org.
COMPLETING G703 -1992
Heading. This information should be completed in a manner consistent with similar information on AIA Document G702, Application and
Certificate for Payment.
Columns A, B C. These columns should be completed by identifying the various portions of the Project and their scheduled values consistent
with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by
sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required.
Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the
original Contract Sum. The total oaf column C may be adjusted by Change Orders during the Project.
Column D. Enter in this column the amount of completed Work covered by the previous application (columns D E from the previous
application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column.
Column E. Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that
were listed on the previous application under Materials Presently Stored (column F).
Column F. Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end
of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet
incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials
are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed —This Period.)
Column C. Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C.
Column H. Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column L This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on
projects where a constant retainage is withheld from the overall contract amount.
Change Orders. Although Change Orders could be incorporated by changing the schedule of value-, each time a Change Order is added to the
Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule.
The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form.
Construction Change Directives. Amounts not in dispute that have been included in Construction Change Directives should be incorporated into
one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201.
The following is an example of a Continuation Sheet (or work in progress. Please note that dollar amounts shown below are for iflusti ative pmposes only, and are
not intended to reflect actual construction costs.
A H C D I: I' G H I
R'URK COMPLETED MATERIALS "ro'I'AL
PR
RALANCF,
f'R RSENTLY AND PLL'TED 'O RLTAINAG
IT E
ITEM L'V A I -1 1LED FROM r.VI011S io l
DI= $[;klE'TIpN C1P \VORK S STORED AND STOR]i0 (IF VARL \RLE
N0. VALUL API'I.ICATION THIS PERIOD (NOT IN 'rO nr11'F. (G -C.) I' G) RATE) {D -'E) 1) OR E) (D +I3 +E) IC -0)
1 MOBILIZATION 5,000 5000 9 0 5000 100 0
2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0
3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0
4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5.000
5 CURBS d MISC. CONC. 5,000 0 0 0 0 0 5,000
6 PAVING, UPPER DRIVE 20.000 0 0 0 0 0 20,000
7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20,000
6 PAVERS 20,000 0 0 10,000 10,000 50 112,000
9 BRICK WORK 5,000 0 0 0 0 0 5,000
10 i 1
11 105.000 2 0,000 1 0,000 10,000 40,000 65,000
AIA Document G703 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING:
his AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any
portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to
reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal
counsel, copyright @aia.org.
TM
.�e
Document G703 -1992
Continuation Sheet
AIA Document G702. APPLICATION AND CERTIFICATION FOR PAYMENT
APPLICATION NO:
containing Contractor's signed certification is attached. COMPLETE MASONRY SERVICES INC. APPLICATION DATE: 16
In tabulations below, amounts are stated to the nearest dollar. AGREEMENT #2695 -4010 PERIOD T0: 03/15/2010
Use Column I on Contracts where variable retainage for line items may apply.
CMS JOB No. 08 -07 03131/2010
ARCHITECTS PROJECT NO:
A B C D INA G H I
WORK COMPLETED MATERIALS TOTAL
BALANCE
SCHEDULED FROM PREVIOUS
PRESENTLY COMPLETED TO RETAINAGE
ITEM DESCRIPTION OF WORK STORED AND STORED {IF VARIABLE
NO VALUE APPLICATION THIS PERIOD (NOT IN TO DATE {G C) FINISH RATE)
(D E) D OR E) (D +E +F) (C G)
13 BALCONY HI CMU
LABOR 195000 195000 195000 00% 0
MATERIALS
CMU 17000 17000 17000 L 00% 0
REBAR 11000 11000 11000 00%
0
GROUT 18000 18000 18000 00% 0
S HEET METAL. 6000 6000 6000 100% 0
MORTAR AND., SAND 5000 5000 5000 00% 0
CCESSORIES 11000 11000 11000 00% 0
14 ATTIC CMU
LABOR 125000 125000 125000 00% 0
MATERIALS
MU 17000 17000 17000 00% 0
REBAR 11000 11000 11000 00% 0
ROUT 18000 18000 18000 00% 0
S HEET METAL 6000 6000 6000 00% 0
MORTAR AND SAND 5000 5000 5000 00% 0
A CCESSORIES 11000 11000 11000 00% 0
15 SEALANTS
UBCONTRACT 85000 84500 500 85000 00% 0
16 DAMPROOFING
S UBCONTRACT 20000 20000 20000 00% 0
17 ALLOWANCE GENERAL 50000 39605 39605 79% 10395
A LLOWANCE -CAD 5000 5000 5000 00% 0
18 C.O. #1 1526 1526 1526 00% 0
19 C.O. #2 -8798 -8798 -8798 00% 0
-5 36 -5036 -5fl36 00% 0
TOTAL 2121692 2097597 13700 0 2111297 00% 10395 106085
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright
Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
possible under the law. Purchasers are permitted to reproduce ten 00) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright @aia.org.
=rile" Document G703"— 1992 Instructions
Continuation Sheet
GENERAL INFORMATION
Purpose and Related Documents. AIA Document 6702, Application and Certificate for Payment, is to be used in conjunction with AIA
Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the
Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction.
Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify
the most recent edition.
Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the
AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further
rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum often copies of a completed
G703, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction
granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users
of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA
Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org.
COMPLETING G703 -1992
Heading. This information should be completed in a manner consistent with similar information on AIA Document G702, Application and
Certificate for Payment.
Columns A, R C. These columns should be completed by identifying the various portions of the Project and their scheduled values consistent
with the schedule of values submitted to the Architect at the commencement of the Project or as Subsequently adjusted. The breakdown may be by
sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required.
Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the
original Contract Sum. The total of column C may be adjusted by Change Orders during the Project.
Column D. Enter in this column the amount of completed Work covered by the previous application (columns D E from the previous
application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column.
Column E. Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that
were listed on the previous application under Materials Presently Stored (column F).
Column F. Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end
of each pay period. This value covers both materials newly stored for which payment is Sought and materials previously stored which are not yet
incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials
are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed —This Period.)
Column G. Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C.
Column FL Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column 1. This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on
projects where a constant retainage is withheld from the overall contract amount.
Change Orders. Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the
Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule.
The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form.
Construction Change Directives. Amounts not in dispute that have been included in Construction Change Directives should be incorporated into
one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201.
The fallowing is an example ofa Conlinualion Sheet for work in progress. Please note that dollar amounts shown below are for illusirarire purposes onlp, and are
not intended to refecl actual constrieclion costs.
A B C D L I 0 II
W RKCUMI'LLl'LL) MATERIALS TOTAL
BALANCE
PRGSEN'I'LV CUMPLP37:U o RE'I'AIN, \GF
17ENI SCIIEDU LED FROM PREVIOUS TO
NO. ot:tiCRll'TION OF MURK VALUE APPLICAFION 711151'FRIOD STORED AND STORED (CI +C) FINISH (I) Ill'VARIABLE
+E) IN'OT IN 10 DATE �C G) RATE)
D OR I?) (DI F =F)
1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0
2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0
3 EARTH WORK 15,000 10,000 5,000 0 15.000 100 0
4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000
5 CURBS MISC. CONC. 5,000 0 0 0 C 0 5,000
6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000
7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20,000
8 PAVERS 20,000 0 0 10,000 10,000 50 10,000
9 BRICK WORK 5,000 0 0 0 0 0 5,000
10
n 105,000 1 20,000 10.000 10,000 40,000 65,000
AIA Document G703TI 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING:
w his AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any
portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to
reproduce ter (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright @aia.org.
f PAYMENT AFFIDAVIT AND PARTIAL WAIVER OF LIEN
_'•',....State of Indiana
County of Delaware
Eric J. Kelly being duly sworn states that he is the President of Complete Masonry Services, Inc. having a
contract with City of Carmel, Indiana acting by and through its Redevelopment Commission to furnish certain
materials for the following project: Parcel 7A Regional Performing Arts Center, located in Camel, Indiana and
owned by Carmel Redevelopment Commission, One Civic Square, Carmel, Indiana 46032 and does hereby
further state on behalf of the aforementioned contractor and that the undersigned is duly authorized to execute
this Affidavit and to bind the Company by the statement herein contained:
`The previous progress payment in the amount of $85873.00, Pay Application No. 13 the receipt of which is
hereby acknowledged.
The material, labor, services or equipment furnished are more particularly described in the application and
certificate for payment (the "Application submitted of even date herewith.
Every subcontractor, laborer, person, corporation or entity performing labor for or furnishing materials to said
Company, in connection with the above mentioned Project has been paid in full for the total amounts due for work
t k..performed or materials supplied to the Project by said person or entity through the date of the application and
certificate referenced above, less only applicable retainage.
The undersigned acknowledges receipt of all funds due for work performed through 11120/2009. The undersigned
affirmatively states that the Company has no claim for additional amounts arising from the work completed as of
the date of the Application, except those which may have been made by submission of a written claim made in
accordance with the contract documents. The Company warrants that it is on schedule and in coordination with all
others in the performance of its work under the contract documents.
r In order to procure one or more payments for services, labor, material or equipment provided in such
'ponstruction, the Company does hereby warrant title to and waive, release and quit -claim in favor of the Owner of
i the real estate and the lender or lenders providing funds with which payment of construction costs is or is to be
made, and their assigns, all liens or claim or right to liens upon the land or improvements above described which
the Company may now have for services, labor, material or equipment furnished in respect of such land or
improvements from the commencement of the project to and including the date set forth above. The undersigned
warrants that the Company has not and will not assign any claim for payment nor any right to perfect a lien
against the real estate.
'That the Company has not employed or procured material from, or subcontracted with, any person or persons,
corpo rations or entities other than those previously submitted to the Owner, and that the Company has complied
with all common wage requirements under applicable law or as may be set forth in the contract documents.
Complete Masonry Services, Inc.
Eric J. Kelly, President
Witness by my hand and notary seal this 20th day of February, 2010
r
y- My Commission Expires: 02/28/2015 r
Resident of Delaware County, Indiana Diann Jennings
PAYMENT AFFIDAVIT AND PARTIAL WAIVER OF LIEN
State of Indiana
County of Delaware
Stephen W. Selvey being duly sworn states that he is the Corp Sec. /Tress. of Complete Masonry Services, Inc.
having a contract with City of Carmel, Indiana acting by and through its Redevelopment Commission to furnish
certain materials for the following project: Parcel 7A Regional Performing Arts Center, located in Carmel, Indiana
and owned by Carmel Redevelopment Commission, One Civic Square, Carmel, Indiana 46032 and does hereby
further state on behalf of the aforementioned contractor and that the undersigned is duly authorized to execute
this Affidavit and to bind the Company by the statement herein contained:
The previous progress payment in the amount of $26,035.80, Pay Application No. 14 the receipt of which
is hereby acknowledged.
The material, labor, services or equipment furnished are more particularly described in the application and
certificate for payment (the "Application submitted of even date herewith.
Every subcontractor, laborer, person, corporation or entity performing labor for or furnishing materials to said
Company, in connection with the above mentioned Project has been paid in full for the total amounts due for work
performed or materials supplied to the Project by said person or entity through the date of the application and
certificate referenced above, less only applicable retainage.
The undersigned acknowledges receipt of all funds due for work performed through 12116/2009. The undersigned
affirmatively states that the Company has no claim for additional amounts arising from the work completed as of
the date of the Application, except those which may have been made by submission of a written claim made in
accordance with the contract documents. The Company warrants that it is on schedule and in coordination with all
others in the performance of its work under the contract documents.
In order to procure one or more payments for services, labor, material or equipment provided in such
construction, the Company does hereby warrant title to and waive, release and quit -claim in favor of the Owner of
the real estate and the lender or lenders providing funds with which payment of construction costs is or is to be
made, and their assigns, all liens or claim or right to liens upon the land or improvements above described which
the Company may now have for services, labor, material or equipment furnished in respect of such land or
improvements from the commencement of the project to and including the date set forth above. The undersigned
warrants that the Company has not and will not assign any claim for payment nor any right to perfect a lien
against the real estate.
That the Company has not employed or procured material from, or subcontracted with, any person or persons,
corporations or entities other than those previously submitted to the Owner, and that the Company has complied
with aH common wage re ents under applicable law or as may be set forth in the contract documents.
Co plete Mas nr r i s, c.
Stephen W. Selvey
Witness by my hand and notary seal this 20th day of March, 2010
My Commission Expires: 02/28/2015
Resident of Delaware County, Indiana Diann Jennings
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Y, Y /z 7 14J -Y 7 3911 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total /3 ?4�.U6
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and i have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
CO��f' ��r5�f� �y 5,p1 vi�ps, /mac IN SUM OF
/V 1V
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoices or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
20/0
nature
Cost distribution ledger classification if
claim paid motor vehicle highway fund